3.2 Efficiency of acupuncture in complex treatment of children with an acute constipation.

According to A.I.Lenjushkina, any episode of an acute delay of a chair should not remain without attention as the acute constipation can lead to formation of a chronic current of disease [35].

In the retrospective analysis of case histories of 352 children who were on inspection and treatment in gastroenterologicheskom unit of branch № 2 MDGKB cities of Moscow with a syndrome of a chronic constipation, it has been shown, that at 34,7 % from them disease began with an acute delay of a chair [67].

On the basis of the above-stated we have studied efficiency of treatment of an acute constipation depending on tactics of observation and treatment in the conditions of an out-patient-polyclinic link which has defined separation of children with the given pathology on 3 groups:

I group - 22 children who have addressed to the doctor on the first week of disease, were under constant observation of the pediatrist within 1 year and receiving basic therapy.

II group - 21 child which also have in due time addressed to the doctor, were under constant observation of the pediatrist and besides basic therapy have received courses of reflexotherapy at the moment of acuteness of a current of disease, and then later 3 - 4 weeks and later 6 months.

III group - 23 children with various terms of the reference to the pediatrist concerning an acute constipation which after the first course of basic therapy were not under observation of the doctor.

At the primary reference to the gastroenterologist references on character and quality of a foodstuff, volume of a consumed liquid, and also exercise stress level, a regimen of day and a defecation of the child have been given all children of investigated groups.

Basic therapy included use of purgatives (lactulose preparations) in age dosages. Considering that fact, that at 84,8 % of patients disturbance of a microflora of the intestine took place, to all children have been prescribed pro-and prebiotiki (atsipol, bifiform, hilak-forte). The painful syndrome against a hypomotor dyskinesia of a colon defined appointment prokinetikov - antagonists of Dofaminum (domperidon), and a hypermotor dyskinesia - selective cholinolytics (giostsina butilbromid) or miotropnyh spazmolitikov with direct action on a smooth musculation (mebeverin). Not last role in stimulation motorno-evakuatornoj colon functions it was taken away also to cholagogue preparations (hofitol) which were prescribed for a period of 2 - 4 weeks.

To children of I group at a delay of a chair more than 3 - 4 days which, as a rule, was accompanied by a painful abdominal syndrome and was the hospitalisation reason in a hospital, more radical stimulation of the certificate of a defecation was prescribed, for what by it were spent abstersive (0,9 % Sodium chloridum solution) or hypertensive (10 % Sodium chloridum solution) clysters during 5 - 10 days with the subsequent transition to lactulose preparations. The patient with cracks of a fundament after a clyster prescribed candles with Calendulae or oblepihovym oil.

To children of II group besides basic therapy the reflexotherapy which has been referred on normalisation motorno-evakuatornoj to colon function, reduction of abdominal pains and a meteorism was spent. For today it is known, that the reflexotherapy at the expense of influence on nejrogumoralnye factors improves metabolic processes in organs and tissues, normalises a motility of a gastroenteric tract and raises allocation of biologically active bonds promoting depression of painful sensitivity [28, 55, 56].

The reflexotherapy was carried out by three courses till 10-12 procedures, daily with a break on the target. Reflexotherapy sessions proceeded on

10-15 minutes depending on age of children, in one session were used 5-7 korporalnyh and 2-3 auricular points. The choice of points was defined taking into account complaints and survey of patients at the moment of treatment.

For improvement motorno-evakuatornoj functions GASTROINTESTINAL TRACT including colon [28, 120] local points in the field of a stomach were used, located on a frontmedian meridian, meridians of a stomach, a lien and kidneys: VC12 chzhun-van, VC6 tsi-find fault, ѴС4гуань-юань, E21 ljan-men, E25 tjan-shu, RP15 yes-hen, RP16 faugh-ah, R16 huan-shu, and also the remote points: E36 a tszu-dignity-whether, GI10 show-dignity-whether, GI11 tsjuj-chi, R3 thaw-si, R6 chzhao-find fault, GI2 ages - tszjan, GI5 jan-si, GI4 he-gu, TR6 chzhi-gou, V25 yes-tub-shu, V27 a sjao-tub-shu, V23 shen-shu, V20 pi-shu, V21 vej-shu. On an auricle following points were applied: АР91 a colon, АР89 a small bowel, АР87 a stomach, АР51 sympathetic, АР43 a stomach, АР194 three parts of a trunk, АР55шэнь-мэнь, АР109 the bottom stomach, АР110 the bottom stomach, АР98 a lien, АР97 a liver, АР34 a brain cortex.

The painful abdominal syndrome defined use of points: VC12 chzhun-van, V45 i-si, E34 ljan-tsju, E36 a tszu-dignity-whether, E44 nej-oozes, VB38 jan-faugh, VB43 sja-si [28, 120].

In the presence of a meteorism such points, as were used: VC14 tszjuj-tsjue, VC6 tsi-find fault, R17 shan-tsjuj, RP2 yes-du, R10 in-gu, RP4 gun-put, F14 tsi-men, VB41 tszu-lin-tsi.

The repeated course was spent through 3 - 4 weeks. The following course of treatment was prescribed in 6 months. The reflexotherapy included different ways of influence on akupunkturnye points: superficial acupuncture by means of the massage platen, korporalnuju and auricular acupuncture, segmentary massage of area of a stomach. The superficial acupuncture was spent on area of a back along a zadne-median meridian and two lines of a meridian of a bladder that fortifying an effect had, and also on stomach area
For reduction of the phenomena of a meteorism and a painful syndrome. Korporalnoe and auricular acupuncture had specific and segmentary an effect.

Katamnestichesky observation over children has shown features of a current of an acute constipation in each group.

In the first group proof normalisation of the certificate of a defecation to the extremity of the first month of treatment at 16 children (72,7 %) became perceptible, at 2 children (9 %) it has been received by third month of treatment, and at 4 children (18 %), including at 2 with kalomazaniem, despite positive dynamics, it was not possible to reach disease remission.

From 18 children (81,8 %) with full clinical remission of disease by third month of treatment, despite regular observation and preventive actions, at 4 children periodically the chair delay again became perceptible, that also has formed the basis for hospitalisation and inspection.

Thus, after 1 year at 8 children (36,4 %) I groups, the chronic current of disease proceeding at 1 child against a megarectum has been diagnosed for 3 children - dolichosigmas and at 4 children as a functional pathology.

Among patients of II group proof normalisation of a defecation became perceptible at 17 children (81 %) in 1 month after treatment, at 3 children (14,3 %) it has been received in 3 months of treatment, and at 1 child with kalomazaniem it was not possible to reach disease remission.

From 20 children with full clinical remission of disease by 3 month of treatment, despite regular observation and preventive actions, at 4 sick (19,1 %) by sixth month of observation periodically again there was a tendency to a chair delay. The given fact has formed the basis for hospitalisation and inspection which has established a dolichosigma at two children, and at two children has not been taped any pathological and anatomic features then it had been spent an acupuncture third year.

At children of III group the reference to the pediatrist concerning a delay of a chair after the first episode took place more later. From 23 patients 14 children, and 5 children have addressed for medical aid to the extremity of the first month - on the third month from the disease beginning, from which 2 children complained not of a constipation (though it at them took place), and on kalomazanie.

To all children of this group at the moment of the primary reference basic therapy has been prescribed. Normalisation of the certificate of a defecation to the extremity of the first month of treatment has taken place only at 9 children (39,1 %), and by third month at 3 children, thus 5 children in connection with absence of positive dynamics and proceeding at 2 of them kalomazaniem, have been referred to a hospital. Inspection has taped at 2 children a dolichosigma, at 1 child - disturbance of obturator function of a sphincter of a rectum, and at 2 children the constipation had functional character. After the spent first course of treatment of 6 children did not address any more to the pediatrist for medical aid.

The analysis of a current of disease at children of III group in 1 year has shown, that from 12 children with clinical remission of disease by third month of treatment at 6 the chair delay proceeded. From 6 children who were not observed at the doctor, three children continued to suffer a chair delay, and at one of them has appeared kalomazanie. Thus, in 1 year from 23 children of III group at 12 children the chronic constipation was generated, and at 3 of them it has become complicated kalomazaniem.

Fig. 3.2.1 Specific gravity of children with a positive effect from treatment on observation groups

In a drawing 3.2.1 a specific gravity of children with the acute constipation, having a positive effect from treatment in 1, 3 and 12 months is presented. Analyzing the obtained data it is possible to draw a conclusion, that in 1 month efficiency of treatment in I and II groups in comparison with III group was authentically above (r1 - 3

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Scientific source IPATOV ANDREY ALEKSANDROVICH. EFFICIENCY of ACUPUNCTURE In COMPLEX TREATMENT of CHILDREN With the CONSTIPATION SYNDROME. The DISSERTATION on competition of a scientific degree of the candidate of medical sciences. Moscow - 2014. 2014

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